Clinical success of pediatric veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is associated with the double lumen cannula cardiovascular device design as well as its anatomic orientation in the atrium. The positions of cannula ports with respect to the vena cavae and the tricuspid valve are believed to play a significant role on device hemodynamics. Despite various improvements in ECMO catheters, especially for the neonatal and congenital heart patients, it is still challenging to select a catalogue size that would fit to most patients optimally...

PURPOSE: The sonographic evaluation of inferior vena cava diameters and its collapsibility-that is also defined as the caval index-has become a popular way to easily obtain a noninvasive estimate of central venous pressure. This is generally considered an easy sonographic task to perform, and according to the American College of Emergency Physicians (ACEP) Guidelines 25 repetitions of this procedure should be sufficient to reach proficiency. However, little is known about the learning process for this sonographic technique...

OBJECTIVE: Fluid responsiveness is the ability to increase the cardiac output in response to a fluid challenge. Only about 50% of patients receiving fluid resuscitation for acute circulatory failure increase their stroke volume, but the other 50% may worsen their outcome. Therefore, predicting fluid responsiveness is needed. In this purpose, in recent years, the assessment of the inferior vena cava (IVC) through ultrasound (US) has become very popular. The aim of our work was to systematically review all the previously published studies assessing the accuracy of the diameter of IVC or its respiratory variations measured through US in predicting fluid responsiveness...

OBJECTIVES: This prospective, observational study evaluated changes in ultrasound measurements of the inferior vena caval index (IVCI), the aorta diameter/IVC diameter index (Ao/IVCD), and the aorta area/IVC area index (Ao/IVCA) during fluid administration in children requiring intravenous fluid administration. METHODS: Children who presented to the pediatric emergency department with symptoms of dehydration were enrolled between May 2015 and February 2016. The maximum diameter of the aorta, from inner wall to inner wall, and the long and short axis diameters of IVC were measured using a convex array transducer in the transverse view...

Introduction: Techniques for measuring volume status of critically ill patients include invasive, less invasive, or noninvasive ones. The present study aims to assess the accuracy of noninvasive techniques for measuring volume status of critically ill patients. Patients and Methods: A total of 111 critically ill patients admitted to the emergency department and undergoing central venous catheterization were included in the study. Five parameters were measured including vascular pedicle width (VPW), diameter of inferior vena cava, caval index, respiratory changes in QRS, and P wave amplitude...

BACKGROUND: Bedside inferior vena cava (IVC) ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI) and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation. METHODS: This was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician's impression of patient volume status and cause of hypotension...

PURPOSE: Dehydration is a very common condition among elderly people. Till date there is not yet a fast and easy method to determine a state of dehydration in the emergency department. In the literature there are some exploratory studies that have tried to establish the relationship between some widely used laboratory values and ultrasound for the purpose of diagnosing dehydration. The primary aim of this study is to verify the correlation between two measures derived by ultrasound (caval index and expiratory diameter of inferior vena cava) and blood urea nitrogen (BUN)/creatinine ratio...

OBJECTIVES: This study aims to determine the correlation of the caval index, inferior vena cava (IVC) diameter, and central venous pressure (CVP) in patients with shock in the emergency room. MATERIALS AND METHODS: This is a prospective double-blind observational study conducted in the emergency room of a tertiary care center. All patients who presented with shock and had a central venous catheter insertion performed were enrolled. The caval index was calculated as a relative decrease in the IVC diameter during the normal respiratory cycle...

BACKGROUND AND OBJECTIVE: Ultrasonography has been suggested as a useful noninvasive tool for intravascular volume assessment in critically ill-patients. Fluid absorption is an inevitable complication of transurethral resection of the prostate (TURP). However, there are few data comparing the caval aortic index with central venous pressure (CVP) measurement for intravascular volume assessment in patients undergoing TURP. MATERIALS AND METHODS: This is a prospective observer blinded study carried out on 50 patients who underwent elective TURP...

BACKGROUND: It is known that respiration modulates cavopulmonary flows, but little data compare mean flows under breath-holding and free-breathing conditions to isolate the respiratory effects and effects of exercise on the respiratory modulation. METHODS: Real-time phase-contrast magnetic resonance combined with a novel method to track respiration on the same image acquisition was used to investigate respiratory effects on Fontan caval and aortic flows under breath-holding, free-breathing, and exercise conditions...

OBJECTIVES: The purpose of this study was to determine whether the inferior vena caval (IVC) diameter is influenced by intravascular volume changes in pregnancy. METHODS: A prospective observational study was done on 2 groups of normal term gravidas. In 24 patients, we measured the IVC diameter, blood pressure, and heart rate (HR) before and after a 1-L fluid infusion in preparation for regional anesthesia, after initiation of an epidural block, and within 24 hours postpartum...

OBJECTIVE: To report our surgical outcomes and experiences with pure conventional retroperitoneal laparoscopic nephrectomy and tumor thrombectomy for patients with right renal tumors and level II inferior vena caval tumor thrombus. MATERIALS AND METHODS: From February 2012 to June 2014, five patients underwent pure conventional retroperitoneal laparoscopic nephrectomy and tumor thrombectomy. After the inferior vena cava was blocked using tourniquet loops above and below the thrombus with the contralateral renal vein being clamped, the inferior vena cava was opened, and the tumor thrombus was fully extracted...

PURPOSE: Since the first report of robotic management of renal tumors with inferior vena cava tumor thrombi, few additional cases have been reported in the literature. We report our combined experience with this procedure, to our knowledge the first multi-institutional and largest series reported to date. MATERIALS AND METHODS: A retrospective, multi-institutional review of robotic nephrectomy with inferior vena cava tumor thrombectomy was performed with institutional review board approval...

OBJECTIVE: Surgical resection for renal cell carcinoma (RCC) with suprahepatic inferior vena cava tumor thrombus is associated with significant morbidity, yet there are currently no tools for preoperative prognostic evaluation. Our goal was to develop a preoperative multivariable model for prediction of survival and risk of major complications in patients with suprahepatic thrombi. METHODS: We identified patients who underwent surgery for RCC with suprahepatic tumor thrombus extension from 2000 to 2013 at 4 tertiary centers...

BACKGROUND: Fluid therapy is the first important step in patients with signs of shock but assessment of the volume status is difficult and invasive measurements are not readily available in the emergency department. We have investigated whether the respiratory variation in diameter of the inferior vena cava is a reliable parameter to predict fluid responsiveness in spontaneous breathing emergency department patients with signs of shock. METHODS: All patients admitted to the emergency department during a 15 week period were screened for signs of shock...

Assessment of respirophasic fluctuations in the diameter of the inferior vena cava (IVC) is detrimentally affected by its concomitant displacements. This study was aimed at presenting and validating a method to compensate for IVC movement artifacts while continuously measuring IVC diameter in an automated fashion (with minimal interaction with the user) from a longitudinal B-mode ultrasound clip. Performance was tested on both experimental ultrasound clips collected from four healthy patients and simulations, implementing rigid IVC displacements and pulsation...

AIM: To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion (ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs. METHODS: Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into the control group (n = 7) and diversion group (n = 7). In the diversion group, portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal pump...

OBJECTIVES: This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring. METHODS: This observational before-and-after study was performed at the intensive care unit of the emergency department. It included hypotensive adult patients with suspected sepsis who were recommended to receive at least 20 mg/kg fluid replacement by the emergency physician. The patients were fluid replaced at a rate of 1000 mL/h, and maximum and minimum IVC diameters were measured and the Caval index calculated sonographically via both B-mode and M-mode...

OBJECTIVES: The purpose of this study was to determine whether sonographic measurement of the inferior vena cava (IVC) in college football players during preseason camp is a reliable way to detect and monitor dehydration. Our primary hypothesis was that IVC diameter measurements, the postpractice caval index, and expiratory diameter were significantly related to percent weight loss after a preseason football practice. METHODS: A prospective cohort sample of Division I intercollegiate football players in preseason training camp was recruited before practice...

STUDY OBJECTIVE: We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter. METHODS: This prospective observational study was conducted at the intensive care unit of the emergency department of a training and research hospital. This study enrolled patients with the main symptom of dyspnea who were categorized into 2 groups, cardiac dyspnea and pulmonary dyspnea groups, based on the final diagnosis...